Abstract
Long-term use of anticholinergics, benzodiazepines and related drugs (or "Z-drugs") have been associated with cognitive impairment and dementia. However, the relationship of these medications with cognitive function and domain-specific neuropsychological performance in older adults without dementia, is unclear. 5135 older adults (74.0±8.3 years; 67.4% female) without a diagnosis of dementia were recruited in Ireland to the Trinity-Ulster-Department of Agriculture (TUDA) study. Detailed cognitive and neuropsychological assessment was conducted using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). A total of 44% (2259 of 5153) used either a potential or definite anticholinergic medication. Overall, 9.7% (n=500) used a definite anticholinergic medication. Regular benzodiazepine use was reported by 7% (n=363), whilst 7.5% (n=387) used a "Z-drug". Use of definite, but not potential anticholinergic medication was associated with poorer performance on all three assessments (β: -0.09; 95% CI: -0.14, -0.03, p=0.002 for MMSE; β: -0.04; 95% CI: -0.06, -0.02; p<0.001 for FAB; β: -4.15; 95% CI: -5.64, -2.66; p<0.001 for RBANS) in addition to all domains of the RBANS. Regular benzodiazepine use was also associated with poorer neuropsychological test performance, especially in Immediate Memory (β: -4.98; 95% CI: -6.81, -3.15; p<0.001) and Attention (β: -6.81; 95% CI: -8.60, -5.03; p<0.001) RBANS domains. Regular use of definite anticholinergic medications and benzodiazepines, but not potential anticholinergics or "Z-drugs", was associated with poorer overall and domain-specific neuropsychological performance in older adults.
Highlights
IntroductionThe use of medications with anticholinergic properties have been associated with the later development of dementia in older adults.[1,2,3,4,5] Medications with such anticholinergic properties, either as an intended/potent side effect, are used to treat a wide range of urological, psychiatric and cardiovascular conditions and are used by significant proportions of older adults.[6,7] Several longitudinal studies have demonstrated a significantly increased risk of incident Mild Cognitive Impairment (MCI) and dementia in those regularly using these medications.[2,8] Less well explored is the specific relationship between these medications and detailed cognitive and neuropsychological performance in community‐dwelling older adults, free from a diagnosis of dementia.One of the most convincing longitudinal studies on anticholinergic medication use and incident dementia, involving just‐under 300,000 individuals, demonstrated significant associations between the use of several types of strong anticholinergic drugs (those with an anticholinergic cognitive burden score of 2 or 3) and the later risk of dementia.[9]
Regular benzodiazepine use was associated with significantly poorer performance on the Mini‐Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS)
Associations between regular Z‐drug use and poorer cognitive performance were seen under unadjusted models for total RBANS in addition to RBANS domain II and III
Summary
The use of medications with anticholinergic properties have been associated with the later development of dementia in older adults.[1,2,3,4,5] Medications with such anticholinergic properties, either as an intended/potent side effect, are used to treat a wide range of urological, psychiatric and cardiovascular conditions and are used by significant proportions of older adults.[6,7] Several longitudinal studies have demonstrated a significantly increased risk of incident Mild Cognitive Impairment (MCI) and dementia in those regularly using these medications.[2,8] Less well explored is the specific relationship between these medications and detailed cognitive and neuropsychological performance in community‐dwelling older adults, free from a diagnosis of dementia.One of the most convincing longitudinal studies on anticholinergic medication use and incident dementia, involving just‐under 300,000 individuals, demonstrated significant associations between the use of several types of strong anticholinergic drugs (those with an anticholinergic cognitive burden score of 2 or 3) and the later risk of dementia.[9]. The relationship of these medications with cognitive function and domain‐ specific neuropsychological performance in older adults without dementia, is unclear. But not potential anticholinergic medication was associated with poorer performance on all three assessments (β: −0.09; 95% CI: −0.14, −0.03, p = 0.002 for MMSE; β: −0.04; 95% CI: −0.06, −0.02; p < 0.001 for FAB; β: −4.15; 95% CI: −5.64, −2.66; p < 0.001 for RBANS) in addition to all domains of the RBANS. Conclusions: Regular use of definite anticholinergic medications and benzodiazepines, but not potential anticholinergics or “Z‐drugs”, was associated with poorer overall and domain‐specific neuropsychological performance in older adults
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